Association of Trabecular Bone Score (TBS) with Incident Fractures in Older Men

小梁骨评分 (TBS) 与老年男性骨折的关联

• 批准号: 9280648
• 负责人: JOHN Torkild SCHOUSBOE
• 金额: $ 19.29万
• 依托单位: HEALTHPARTNERS INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-02-01 至 2017-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9280648
• 关键词: Association; Trabecular; Bone; Score; TBS

DESCRIPTION (provided by applicant): Fractures related to osteoporosis are an important cause of morbidity, and in the case of hip fractures, of mortality in the older male population. Since osteoporosis is asymptomatic until a fracture occurs, successful reduction of the societal burden of fractures in men will require that strategies that can identify the subset of men who are at high risk of suffering a fracture, and who should be treated to reduce that risk. Current prediction models have had only partial success achieving this goal, and models incorporating new aspects of bone biology such as bone microstructure are needed to improve fracture prediction in men. In order to be practically applicable to screening a large subset of the overall population as older men represent, such measures need to inexpensive, practical, and easy to implement in clinical practice. Trabecular Bone Score (TBS), a surrogate measure of trabecular microarchitecture, can be easily measured on spine bone density scans (that are routinely done as part of bone density tests) simultaneously as spine bone density is measured. TBS has been shown to be a predictor of major osteoporotic, hip, and clinical vertebral fractures in women, but how well it predicts fractures in men has never been tested. Predictors of changes of TBS over time also have not been explicated. Since TBS is driven by that component of bone (trabecular) with high metabolic activity, there is the possibility that TBS could be a more sensitive indicator of changes in bone strength than areal BMD of the spine (which is often confounded by degenerative changes and aortic calcification) or of the hip (which is mostly cortical bone). Moreover, preliminary evidence from one trial suggests that TBS significantly improves with treatment with at least one therapeutic agent (denosumab), and there is the possibility that TBS could be a more sensitive indicator of response to pharmacologic fracture prevention therapy than other currently available measures. In this ancillary study to the main Osteoporotic Fractures in Men (MrOS) study, and in response to PA-11-261, we propose to measure TBS on the spine bone density scans obtained on 5,994 participants at the baseline visit and 4,485 men attending the second study visit. Our specific aims are; 1) Test the hypotheses that TBS is independently associated with incident hip, radiographic vertebral, and major osteoporotic fractures (clinically evident fractures of the hip, spine, proximal humerus, or distal radius); 2) Test the hypothesis that the addition of TBS to fracture prediction models in older men improves their discrimination of those who will have a fracture from those who will not; and 3) Determine predictors of changes of TBS score between MrOS visits 1 and 2. Establishing the clinical utility of TBS in fracture risk assessment in men will lay the foundation for application in clinical practice to improve fracture prediction and reduce the societal burden of osteoporotic fractures in men.

描述（由申请人提供）：与骨质疏松症有关的骨折是发病率的重要原因，在髋部骨折的情况下，男性骨折死亡率。由于骨质疏松症是无症状的，直到发生骨折，因此男性骨折的社会骨折负担成功减轻了这些策略，这些策略可以识别出遭受骨折的高风险的人群，并应接受治疗以降低这种风险。当前的预测模型只有部分成功实现了这一目标，并且需要结合骨生物学的新方面，例如骨微结构，以改善男性的断裂预测。为了实际上适用于筛选整体的大部分 作为老年男性代表的人口，这种措施需要在临床实践中廉价，实用且易于实施。小梁骨评分（TBS）是小梁微体系结构的替代量度，可以同时在脊柱骨密度扫描（通常作为骨密度测试的一部分进行）上轻松测量，因为脊柱骨密度被测量。 TBS已被证明是女性主要骨质疏松，髋关节和临床椎骨骨折的预测指标，但预测男性骨折的良好状况从未被测试过。 随着时间的推移，TBS变化的预测因素尚未阐明。由于TBS是由具有高代谢活性的骨头（小梁）的组成部分驱动的，因此TBS可能是更敏感的指标 骨强度的变化比脊柱的面积BMD（通常是由退化性变化和主动脉钙化混淆）或髋部（主要是皮质骨）。此外，一项试验的初步证据表明，用至少一种治疗剂（Denosumab）的治疗可以显着改善，并且有可能与其他当前可用的措施相比，TBS可能是对预防药理骨折治疗的反应的更敏感的指标。在对男性（MROS）研究中主要骨质疏松性骨折的辅助研究中，并在响应PA-11-261的研究中，我们建议在基线访问中对5,994名参与者获得的脊柱骨密度扫描进行测量，并在基线访问中获得4,485名参加第二次研究访问的男性。我们的具体目标是； 1）检验了TBS与入射髋关节，射线照相椎骨和主要骨质疏松性裂缝（髋关节，脊柱，脊柱近端肱骨或远端半径的临床明显骨折）独立相关的假设； 2）检验以下假设：在老年男性中，将TBS添加到骨折预测模型中可以改善他们对那些不会因不会裂缝的人的歧视。 3）确定MROS访问1和2之间TBS得分变化的预测因素。建立男性断裂风险评估中TBS的临床实用性将为临床实践中的应用奠定基础，以改善断裂预测并减轻男性骨质疏松剂的社会负担。